Influence of antiplatelet drugs on gastric ulcer healing after endoscopic submucosal dissection in patients with early gastric cancer

Abstract

Abstract Objectives The causes of drug‐induced gastroduodenal injuries primarily include antithrombotic drugs, including low‐dose aspirin, non‐steroidal anti‐inflammatory drugs, and corticosteroids. These drugs are suspected to affect gastric ulcer healing after endoscopic submucosal dissection (ESD). This study aimed to investigate the effects of these drugs on post‐ESD ulcer healing. Methods This study included 170 lesions (149 patients) who had undergone ESD for early gastric cancer. Post‐ESD ulcers were endoscopically measured on the 1st, 28th, and 56th days after ESD and were analyzed to identify potential risk factors for delayed ulcer healing among patients taking antiplatelet drugs, anticoagulant drugs, non‐steroidal anti‐inflammatory drugs, corticosteroids, and no drugs. Results Multivariate analysis for the frequency of scarring on the 56th day after ESD showed that antiplatelet drugs (odds ratio [OR], 3.905; p = 0.017), ulcer size of ≥40 mm on the first day (OR, 4.903; p = 0.006), hemoglobin A1c ≥6.5% (OR 7.659, p = 0.012), and age of ≥75 (OR, 5.227; p = 0.007) were independent risk factors of delayed ulcer healing. Anticoagulant drugs, non‐steroidal anti‐inflammatory drugs, and corticosteroids were not significant factors. Among antiplatelet drugs, the ulcer reduction ratio for clopidogrel on the 28th day after ESD was 84.8%, which was significantly lower than the ulcer reduction ratio of 92.8% for no drug (p < 0.05). Conclusions As antiplatelet drugs, particularly clopidogrel, may delay gastric ulcer healing after ESD, careful endoscopic follow‐up and drug therapy are suggested for patients taking these drugs.

Keywords

• aspirin
• clopidogrel
• endoscopic submucosal dissection
• platelet aggregation inhibitors
• stomach ulcer